General Considerations
Important guidelines and precautions for optimal recovery
Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation, physician appointments as well as continued assessment by the treating practitioner should dictate progress.
Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks.
Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization and friction massage) to decrease fibrosis.
No direct scar mobilization at surgical portals until 4 weeks post operative, "no touch zone" 2 inches from portals. See wound care protocol for full details.
All exercises should be carefully observed for any signs of compensation or guarding.
No running, jumping, or ballistic activities for 6 months. Aerobic and general conditioning throughout the rehabilitation process.
M.D./nurse appointments at Day 1-2, Day 14, 1 month, 3 months, 6 months, and 1 year post-op.
Weeks 0 - 3
Initial recovery phase - Non-weight bearing
Appointments & Initial Care
- Appointment with nurse Day 2 for dressing change and review home program.
- Appointment with nurse Day 14 for stitch removal.
- Adjustable boot locked out at 30 degrees of plantar flexion.
- Nonweightbearing for 3 weeks--no push off or toe-touch walking.
- Pain and edema control (i.e. cryotherapy, electric stimulation, soft tissue treatments).
Manual Therapy
Soft tissue mobilization to ankle/foot/effleurage for edema.
Avoid direct palpation to suture line (keep 2 inch "no touch zone" around portals x 4 weeks).
Exercises
Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension.
Well-leg cycling, weight training, and swimming for cardiovascular.
- Decrease pain, edema
- Gait non weight bearing with axillary crutches/boot
Weeks 3 - 8
Progressive weight bearing phase
Weight Bearing Progression
Walking orthosis set at 30 degrees plantar flexion at 3 weeks; adjust 10 degrees per week.
Gradually increase weight bearing from toe-touchdown to partial as tolerated and as able per range of motion (heel contact once partial weight bearing).
After 6 weeks, okay to progress to full weight bearing.
Manual Therapy
- Soft tissue mobilization to ankle, foot, effleurage for edema.
- Initiate gentle passive range of motion dorsiflexion (not past neutral), inversion, eversion per tolerance- cautious for percutaneous, open repair more stable.
- At 4 weeks initiate scar mobilization once incisions completely closed.
Exercises
- Straight leg raises, side-lying hip abduction, Straight legged bridges.
- Isometrics of uninvolved muscles.
- Light active dorsiflexion of the ankle until gentle stretch of Achilles after 4 weeks.
- Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot.
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks.
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns for hip and knee (not to Achilles).
- At 6 weeks, okay to add stationary cycling with heel push only.
- 0 degrees Dorsiflexion
- After 6 weeks progress to full weight bearing, discharge crutches
Weeks 8 - 16
Advanced rehabilitation and strengthening phase
Progression Guidelines
- Discharge orthotic boot at 8 weeks and progress into shoes with heel lift.
- Begin progressive gait training program.
- Increase intensity and duration of strengthening exercises.
Manual Therapy
- Continue soft tissue mobilization and scar management.
- Progressive passive and active range of motion exercises.
- Joint mobilization as needed for ankle and foot mobility.
Strengthening Exercises
- Progressive resistance exercises for ankle plantar flexion.
- Double leg heel raises progressing to single leg.
- Balance and proprioception training.
- Pool exercises for resistance and cardiovascular training.
- Stationary cycling with progressive resistance.
- Full active range of motion
- Normal gait pattern without assistive device
- Good strength and endurance for daily activities
Weeks 16 - 24
Return to activity preparation phase
Activity Progression
- Initiate running program if strength and ROM goals are met.
- Progressive plyometric exercises.
- Sport-specific training drills as appropriate.
- Continue strengthening and conditioning program.
Advanced Exercises
- Single leg heel raises with progressive resistance.
- Eccentric strengthening exercises.
- Jumping and hopping progressions.
- Agility drills and direction changes.
- Return to full activities of daily living
- Adequate strength for sport-specific activities
- Good dynamic balance and control
Return to Sport (6+ Months)
Final phase - Full activity clearance
Criteria for Return
- Physician clearance required.
- Full pain-free range of motion.
- 90% strength compared to uninvolved side.
- Successful completion of sport-specific functional testing.
- No pain or swelling with activities.
Prevention & Maintenance
- Continue strengthening program 2-3 times per week.
- Maintain flexibility with regular stretching.
- Gradual progression of training intensity.
- Proper warm-up and cool-down routines.
- Monitor for any signs of re-injury or complications.